| Blue Kite Wellness | |
|
1761 S Naperville Rd Ste 103 Wheaton IL 60189-5846 | |
| (630) 635-0577 | |
| Not Available |
| Full Name | Blue Kite Wellness |
|---|---|
| Speciality | Counselor |
| Location | 1761 S Naperville Rd Ste 103, Wheaton, Illinois |
| Authorized Official Name and Position | Dhruvil Pandya (PRESIDENT) |
| Authorized Official Contact | 2245226618 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Kite Wellness 4755 Karns Ave Lisle IL 60532-1666 Ph: (224) 522-6618 | Blue Kite Wellness 1761 S Naperville Rd Ste 103 Wheaton IL 60189-5846 Ph: (630) 635-0577 |
| NPI Number | 1053064352 |
|---|---|
| Provider Enumeration Date | 01/27/2022 |
| Last Update Date | 10/30/2024 |
| Certification Date | 10/30/2024 |
| Medicare PECOS PAC ID | 1658758123 |
|---|---|
| Medicare Enrollment ID | O20220523001451 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053064352 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (NU) | Primary |
| 207Q00000X | Family Medicine | (NU) | Secondary |
| Provider Name | Jessica M Fino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427519156 PECOS PAC ID: 4789010067 Enrollment ID: I20200205000128 |
| Provider Name | Candace Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619534203 PECOS PAC ID: 9638525975 Enrollment ID: I20231024000517 |
| Provider Name | Alexandra H. Derivera |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225781388 PECOS PAC ID: 5294272472 Enrollment ID: I20240806001166 |
| Provider Name | Samantha Nolan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295311397 PECOS PAC ID: 5294222428 Enrollment ID: I20251013002169 |
| Provider Name | Sherry L Green |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982244091 PECOS PAC ID: 5193206076 Enrollment ID: I20260227003353 |
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